Extraintestinal manifestations are common in inflammatory bowel disease; however, muscular involvement in Crohn disease is rarely reported. We present a case of a 26-year-old male with ileocolonic Crohn disease who developed sudden tenderness in both calves. Doppler ultrasound was negative for deep vein thrombosis. Magnetic resonance imaging of the gastrocnemius muscle showed high intensity signal in the muscle fibers, and muscle biopsy demonstrated nonspecific lymphocytic myositis. Other relevant laboratory results included normal antineutrophil cytoplasmic antibodies and creatine kinase as well as elevated C-reactive protein, erythrocyte sedimentation rate, and anti-Saccharomyces cerevisiae IgG titer. The patient was in clinical remission, being treated with azathioprine 2.5 mg/kg. Prednisone 60 mg/day was initiated with rapid resolution of calf tenderness; however, tenderness soon returned when the dose was tapered to 10 mg/day. Subsequently, prednisone and azathioprine were discontinued, and adalimumab was started at standard induction and maintenance doses. The patient’s symptoms resolved shortly after the first induction dose. A repeat magnetic resonance imaging of the calves – 3 months after starting adalimumab – showed complete resolution of muscle inflammation. To our knowledge, this is the first case of gastrocnemius myositis – a rare extraintestinal manifestation of Crohn disease – successfully treated with anti-tumor necrosis factor agents.

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objeCtives: To assess EQ-5D-5L validity in patients with acute stroke, in comparison to EQ-5D-3L, EQ VAS, modified Rankin Scale (mRS) and Barthel Index (BI). Methods: Cross-sectional study of 408 patients (51.5% males; mean age 69 years), after median 8 days from stroke onset. We assessed: construct validity in terms of known-groups validity, convergent validity of EQ-5D-5L dimensions with other stroke outcome measures, and criterion-related validity in terms of concurrent validity, with mRS as a gold standard. Results: A total of 2.9% EQ-5D-5L and 3.7% EQ-5D-3L questionnaires had at least one missing answer, indicating good feasibility of both instruments in patients with stroke. The proportion of patients reporting 'no problems' was 38.2% for BI, 6.1% for EQ-5D-3L, 5.6% for EQ-5D-5L, 5.0% for mRS and 2.5% for EQ VAS. Results of the known-groups validity tests confirmed prior hypotheses: health state utilities were lower in females, patients with high mRS score, low BI or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as EQ-5D-3L dimensions. For predicting outcome in patients with stroke, the sum of mRS related EQ-5D-5L dimensions (Mobility, Self-care, Usual activities), gave 1% of false positive and 0% of false negative results. ConClusions: Results support the validity of the EQ-5D-5L descriptive system as a generic measure assessed by self-report and proxy in patients with acute stroke, demonstrating some psychometric advantages in comparison to EQ-5D-3L and substantially lower ceiling effect in comparison to Barthel Index.

nomical standpoint, the total avoidable cost with TPN mounted to 2,48,200 Indian Rupees. ConClusions: Proper use of TPN reduced mortality in post-surgical patients. Greater attention to nutritional assessment to determine calorific need and nutritional requirement for individual patients should further improve benefits, reduce mortality and save treatment costs in hospitalized patients. PGI44 A HeAltH tecHnoloGy-RelAted cost descRIPtIon conceRnInG ItAlIAn Ibd centRes deAlInG WItH cRoHn's dIseAse: Results FRom sole study